基质金属蛋白酶-2和基质金属蛋白酶组织抑制因子-2在卵巢浆液性囊腺癌中的表达及意义

目的:研究基质金属蛋白酶-2(MMP-2)和基质金属蛋白酶组织抑制因子-2(TIMP-2)在卵巢浆液性囊腺肿瘤中的表达及与卵巢浆液性囊腺癌的临床、病理特征之间的关系.方法:通过免疫组化方法检测16例卵巢浆液性囊腺瘤、15例交界性卵巢浆液性囊腺瘤及40例卵巢浆液性囊腺癌中MMP-2和TIMP-2的表达情况,并应用图像分析仪对卵巢浆液性囊腺癌MMP-2、TIMP-2阳性细胞百分面积进行定量检测,计算MMP-2/TIMP-2比值.结果:卵巢浆液性囊腺瘤、交界性卵巢浆液性囊腺瘤及卵巢浆液性囊腺癌中MMP-2的表达分别是25%、60%、73%,TIMP-2的表达分别是31%,47%,63%.MMP-2/TIMP-2比值在卵巢浆液性囊腺癌Ⅲ、Ⅳ期较Ⅰ、Ⅱ期增大,低分化(G3)较中、高分化(G2、C1)增大.结论:MMP-2和TIMP-2可能均与卵巢浆液性囊腺癌的形成和进展有关.     

卵巢肿瘤中B7-H1、B7-H3分子的表达及临床意义

目的探讨B7-H1、B7-H3在卵巢上皮性良性肿瘤、交界性肿瘤及各类卵巢恶性肿瘤组织中的表达及其临床意义。方法采用ElivsionTM免疫组织化学染色法检测B7-H1、B7-H3分子在84例卵巢肿瘤组织中的表达情况,其中卵巢浆液性囊腺瘤10例,交界性浆液性囊腺瘤20例,恶性肿瘤54例（浆液性囊腺癌36例,非浆液性囊腺癌18例）。比较B7-H1、B7-H3分子在卵巢上皮性良性肿瘤、交界性肿瘤及恶性肿瘤组织中的表达水平,并对其中54例卵巢恶性肿瘤组织中B7-H1、B7-H3的表达水平与年龄、病理类型、病理分期、病理分级及淋巴结转移之间的关系进行统计学分析。结果B7-H1、B7-H3分子主要表达于卵巢恶性肿瘤细胞的细胞质及细胞膜上,呈弥漫性棕黄色颗粒状染色。B7-H1分子在卵巢浆液性囊腺瘤、交界性浆液性囊腺瘤、浆液性囊腺癌中的阳性表达率分别为10．0％（1／10）、30．0％（6／20）、66．7％（24／36）,三者之间的差异有统计学意义（x^2=13．41,P〈0．05）。B7．H3分子在卵巢浆液性囊腺瘤、交界性浆液性囊腺瘤、浆液性囊腺癌中的阳性表达率分别为0．0％、25．0％（5／20）、69．4％（25／36）,三者之间的差异有统计学意义（x^2=20．07,P〈0．05）。恶性组中,B7-H1、B7-H3的表达水平与卵巢恶性肿瘤的FIGO分期、病理类型、病理分级、淋巴结转移或年龄等无显著相关性（P〉0．05）。结论B7-H1、B7-H3分子在卵巢恶性肿瘤中高表达,且恶性组表达阳性率明显高于交界组和良性组,提示其可能与肿瘤的发生发展有关,有望成为评估卵巢恶性肿瘤生物学行为的新的分子标志物。     

PECAM-1在卵巢上皮性浆液性囊腺癌中的表达及其临床意义

目的探讨血小板内皮细胞黏附分子-1(PECAM-1)在正常卵巢上皮和不同病变卵巢组织中的表达及其临床意义。方法用实时RT-PCR和免疫组化法检测了124例卵巢上皮性浆液性囊腺癌、76例卵巢交界性浆液性囊腺瘤、132例卵巢浆液性囊腺瘤、48例正常卵巢上皮中PECAM-1的表达,并分析PECAM-1的表达与卵巢上皮性浆液性囊腺癌患者年龄、临床分期以及病理分级的相关性。结果实时RT-PCR结果显示,在正常卵巢上皮、卵巢浆液性囊腺瘤、卵巢交界性浆液性囊腺瘤、卵巢上皮性浆液性囊腺癌中,PECAM-1 mRNA的表达量分别为0.237±0.057,0.298±0.069,0.543±0.174,0.825±0.124,差异有统计学意义(F=531.992,P<0.05)。随着病变程度的加重,PECAM-1在4组中的表达逐渐增强,差异有统计学意义(Z=65.36,P<0.01)。PECAM-1的表达与卵巢上皮性浆液性囊腺癌FIGO临床分期(r=0.302,P<0.01)和病理分级(r=0.196,P<0.05)有显著相关性。结论 PECAM-1的表达随卵巢病变程度的加重而增高,且与卵巢上皮性浆液性囊腺癌病理分级和临床分期呈正相关。     

VEGF及PCNA在卵巢上皮性肿瘤中的表达

目的探讨VEGF、PCNA表达在卵巢浆液性上皮性肿瘤进展中的作用。方法采用SP免疫组化染色法检测19例卵巢浆液性囊腺癌、15例交界性浆液性囊腺瘤和13例浆液性囊腺瘤中VEGF、PCNA的表达情况。结果浆液性囊腺癌中VEGF及PCNA显著高于交界性浆液性囊腺瘤和浆液性囊腺瘤，交界性浆液性囊腺瘤中VEGF、PCNA显著高于浆液性囊腺瘤；VEGF、PCNA在Ⅲ级卵巢浆液性囊腺癌中的表达显著高于Ⅰ-Ⅱ级；不同临床分期VEGF、PCNA表达没有显著差异。相关分析显示VEGF的表达与PCNA呈显著正相关。结论VEGF及PCNA在卵巢浆液性囊腺癌和交界性浆液性囊腺瘤中呈高表达，表明其与卵巢浆液性上皮性肿瘤的进展有关；随着癌组织分级的增高，VEGF、PCNA呈高表达，但与临床分期无关，显示其可能是评估卵巢浆液性上皮性肿瘤良、恶性程度的辅助指标。     

骨桥蛋白在卵巢癌组织中的表达及意义

目的探讨骨桥蛋白(OPN)在卵巢癌组织中的表达及临床意义。方法采用免疫组化法检测35例上皮性卵巢癌组织、17例交界性卵巢肿瘤、15例卵巢良性肿瘤组织及6例正常卵巢组织标本中OPN的表达,分析其与临床病理特征的关系及相关性。结果 OPN在上皮性卵巢癌、交界性卵巢肿瘤、卵巢良性肿瘤及正常卵巢组织中阳性表达率分别为69%、65%、26%及0%(P<0.05)。OPN在卵巢浆液性囊腺癌及黏液性囊腺癌组织表达不具有统计学差异(P>0.05)。结论OPN在卵巢癌组织中显著高表达;其表达和术前血CA125水平相关,是卵巢癌早期诊断、病情监测及评价预后的生物标志物之一。     

IMP3、P16蛋白、HE4、P53蛋白在卵巢浆液性肿瘤中表达及其临床意义

目的探究胰岛素样生长因子ⅡmRNA结合蛋白3(IMP3)、P16蛋白、人附睾蛋白4(HE4)、P53蛋白在卵巢浆液性肿瘤中表达及其临床意义。方法采用免疫组织化学法对2010年11月至2017年11月该院卵巢浆液性囊腺瘤204例(良性组),卵巢交界性浆液性肿瘤42例(交界性组),卵巢浆液性癌64例(恶性组)组织进行IMP3、P16蛋白、HE4及P53蛋白检测并分析临床病理意义。结果 IMP3、P16蛋白、HE4在良性组中的阳性表达率(15.20%、24.02%和25.00%)明显低于交界性组(54.76%、71.43%和71.43%)和恶性组(73.44%、85.94%和75.00%),差异均有统计学意义(P0.05);P53蛋白在良性组(4.90%)和交界性组(4.76%)阳性表达率明显低于恶性组(42.19%),差异均有统计学意义(P0.05);IMP3、HE4和P53蛋白阳性表达率在不同分化程度卵巢浆液性癌间比较,差异均具有统计学意义(P0.05);HE4阳性表达率在盆腔淋巴结有无转移者间比较,差异具有统计学意义(P0.05);四项指标联合检测卵巢浆液性囊腺癌灵敏度(92.19%)和特异度(96.88%),显著高于IMP3(分别为42.19%和60.94%)和P16蛋白单项检测(分别为40.62%和45.31%),差异均有统计学意义(P0.05)。IMP3、P16蛋白、HE4和P53蛋白联合检测的受试者工作特征曲线(ROC曲线)下面积0.869显著高于各指标单独检测的曲线下面积(P0.05);在四项指标的单独检测中,HE4的ROC曲线下面积0.816最大(P0.05)。结论 IMP3、P16蛋白、HE4和P53蛋白联合检测能够提升临床卵巢浆液性癌的诊断率,有望成为卵巢浆液性癌检测良好指标。     

卵巢上皮癌组织中MUC4和CA125的表达及其临床意义

目的:探讨MUC4和CA125在卵巢上皮性癌组织中的表达及临床意义。方法:采用PV-9005免疫组化二步法检测59例卵巢上皮癌、19例卵巢交界性肿瘤、16例卵巢良性肿瘤和11例正常卵巢组织中MUC4和CA125的表达情况。结果:MUC4和CA125的阳性表达率在卵巢上皮癌中显著高于卵巢交界性肿瘤、卵巢良性肿瘤和正常卵巢组织(P<0.05)。MUC4阳性表达率在卵巢上皮癌低分化组显著高于高-中分化组(P<0.05);CA125阳性表达率在卵巢上皮癌晚期、低分化、有淋巴结转移组显著高于早期、高-中分化、无淋巴结转移组(P<0.05),CA125阳性表达率在浆液癌组显著高于黏液癌和透明细胞癌(P<0.05)。卵巢上皮癌中MUC4和CA125的表达呈正相关(P<0.05)。结论:MUC4和CA125在卵巢上皮癌的发生发展中可能起重要作用。     

卵巢上皮性肿瘤端粒酶活性原位检测的临床病理研究

目的　探讨端粒酶活性原位检测在卵巢良、恶性上皮肿瘤诊断与鉴别诊断中的价值。方法　采用端粒酶活性原位检测法 (ISLT法 )和核仁组成区相关蛋白 (AgNORs)技术检测 88例卵巢上皮性肿瘤组织 ,其中囊腺癌 2 6例 ,交界性囊腺瘤 2 1例 ,囊腺瘤 15例 ,囊腺癌癌旁组织 2 6例。结果　卵巢囊腺癌 ,交界性囊腺癌 ,囊腺瘤 ,囊腺癌癌旁组织端粒酶检出率分别为 92 .3% ,4 2 .8% ,0。囊腺癌组端粒酶阳性率与交界性囊腺瘤 ,囊腺瘤 ,囊腺癌癌旁组织存在显著差异 (P <0 .0 1)。其端粒酶阳性检出率与患者年龄 ,肿瘤大小 ,病理类型 ,有无腹水、淋巴结转移 ,分化程度及临床分期无明显相关性 (P >0 .0 5 )。卵巢囊腺癌AgNORs总面积为 0 .92 6 9± 0 .2 0 39μm2 ,与其他组有显著差异 (P <0 .0 1) ,并端粒酶活性强度之间具有显著相关性 (rs=0 .910 ,P <0 .0 1)。交界性囊腺瘤组 9例端粒酶阳性的AgNORs总面积为0 .74 83± 0 .0 36 3μm2 ,12例端粒性酶阴性的AgNORs总面积为 0 .5 870± 0 .1381μm2 ,两者有显著差异 (P <0 .0 1)。结论　LSLT法和AgNORs在卵巢囊腺癌的确诊和交界性囊腺瘤与囊腺瘤的诊断与鉴别诊断中有重要的参考价值。     

钙磷脂结合蛋白Ⅱ在卵巢腺癌中的表达及其意义

目的 探讨钙磷脂结合蛋白Ⅱ(Annexin Ⅱ)在卵巢腺癌中的表达及其临床意义.方法 采用免疫组化SP法检测48例卵巢腺癌和10例卵巢腺瘤组织中Annexin Ⅱ蛋白的表达,并对样本表达率进行χ2检验.结果 Annexinll蛋白阳性率在卵巢腺瘤组织中为50.00%(5/10),在卵巢腺癌组织中为81.25%(39/48),差异有统计学意义(χ2=4.414,P<0.05);Annexin Ⅱ蛋白在卵巢浆液性腺癌高、中分化组及低分化组中的阳性率分别为93.33%(14/15)和78.95%(15/19),差异无统计学意义(χ2=1.383,P0.05);Annex-in Ⅱ蛋白在卵巢浆液性腺癌Ⅰ、Ⅱ期及Ⅲ、Ⅳ期组织中的阳性率分别为60.00%(6/10)和95.83%(23/24),差异有统计学意义(χ2=7.226,P<0.05);Annexin Ⅱ蛋白在卵巢浆液性腺癌淋巴结转移组阳性率为90.00%(27/30),而在无淋巴结转移组为50.00%(2/4),差异有统计学意义(χ2=4.502,P<0.05).结论 AnnexinⅡ蛋白阳性表达与卵巢浆液性腺癌的发生、发展和淋巴结转移有关.     

NAC1、FOXQ1在不同级别卵巢浆液性癌组织中表达及其临床意义

目的通过检测伏隔核相关因子1(NAC1)、FOXQ1在卵巢浆液性癌中的表达情况,探讨NAC1、FOXQ1在卵巢浆液性癌发生、发展及侵袭中的可能作用和临床意义。方法选取卵巢浆液性癌标本80例,其中低级别浆液癌36例,高级别浆液性癌44例。选取同期卵巢肿瘤40例患者,其中20例为卵巢浆液性囊腺瘤,20例为卵巢交界性浆液性囊腺瘤;另取正常卵巢组织标本20例进行对照。采用免疫组化法检测NAC1、FOXQ1各组织中的表达情况,并分析其与病理分期、淋巴结转移及其患者预后生存率的关系。结果 NAC1在浆液性囊腺瘤、正常组织中无表达,在交界性囊腺瘤呈弱阳性,在低、高级别卵巢浆液性癌组织中表达率分别为44.4%、59.1%,差异有统计学意义(P0.05);FOXQ1在恶性卵巢肿瘤、交界性肿瘤、卵巢良性肿瘤、正常卵巢组织中均有表达,FOXQ1在高级别浆液性卵巢癌、低级别浆液性卵巢癌、交界性囊腺瘤、浆液性囊腺瘤、正常卵巢组织中的阳性表达分别呈逐渐降低趋势(P0.05);NAC1、FOXQ1在高级别浆液性癌组织中不同病理分期阳性表达率比较,差异有统计学意义(P0.05),随病理分期增加阳性表达呈递增趋势;NAC1、FOXQ1在高级别浆液性癌阳性表达淋巴结转移情况大于低级别,差异有统计学意义(P0.05);高级别卵巢浆液性癌中NAC1、FOXQ1阳性表达患者3年生存率低于阴性表达患者,差异有统计学意义(P0.05),而5年生存率比较,差异无统计学意义(P0.05)。结论 NAC1、FOXQ1在卵巢高级别浆液性癌中阳性表达最强,二者可能参与了卵巢高级别浆液性腺癌的发病过程,NAC1、FOXQ1过表达与高级别卵巢浆液性癌患者的生存率有关,可作为一个独立的卵巢癌不良预后指标。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.